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Question 1

Health Practitioner must: (Pharma)
and with that knowledge HCW can….

Answer 1

Health Practitioner must:
• Understand drugs and how they work
• Be able to judge the efficacy of medication and recognise any adverse or unintended effects

With knowledge, Health Practitioner can minimize any harm associated with administering medications.

Question 2

With knowledge health practitioner can….

Answer 2

minimize any harm associated with administering medications

Question 3

What is Pharmacology?

Answer 3

-is science focus on Studying the actions of drugs.
—It Incorporates knowledge form other sciences [Pharmacodynamics & Pharmacokinetics].
—Understanding drug’s mechanism of action at molecular level is critical for understanding drug effects, interactions, adverse effects, and logic behind dosing regimens.

Question 4

What is a drug?

Answer 4

Drugs are substances or chemicals capable of altering a biochemical or physiological process(es) in the body, either desirable (therapeutic) or undesirable (adverse) effects. They only modify existing functions in the human body.

Question 5

What are medication?

Answer 5

are drugs used to restore a dysfunctional or pathologic process in the body to its desired function or process.

Question 6

Drug classifications?

Answer 6

Drug classified by either:
• How they affect body systems.
• Therapeutic use.
• Chemical Characteristic [Drugs within a category have similar features]

Question 7

Drug names?

Answer 7

Trade/brand name (commercial name)
• Assigned by company that manufactures drug.
• e.g., Tylenol®, Panadol®, and Adol® are different brand names of paracetamol

Generic name
• Official drug name by the WHO.
• The drug has the same generic name all over world. It gives a clue to the class of the drug, e.g. :
✓ Proranolol, atenolol, esmolol, metoprolol_ all are β-blockers.
✓ Cimetidine, ranitidine, famotidine_ all are H2 receptor blockers.

Question 8

Legal ways to access drugs?
What does each one need?

Answer 8

Legal ways to access drugs:

-Prescription: require prescription from a licensed provider: dispensed only on prescriptions, these drugs considered unsafe for used except under medical supervision, e.g., diazepam, phenobarbitione

-Non prescription/ Over-the-counter (OTC); don’t require official prescription from a licensed provider: these drugs are available directly to the public without a prescription. They are considered safe for used without medical supervision, e.g., analgesics, antidiarrheal, allergy, antacids and cold and cough remedies.

Question 9

Role of the Physiotherapy in Drug prescription?

Answer 9

Physiotherapy are illegitimate to prescribe drugs. But they can direct patients to proper OTC medicines.

Question 10

Sources of drug information

Answer 10

• Pharmacology textbook
• Drug reference guides
• Authoritative sources [Drug Information Centers in Hospitals]
• Package inserts
• Online resources [Micromedex, Lexicomp]
• Continuing education, [Research]

Question 11

Controlled substances stands for?

Answer 11

Comprehensive Drug Abuse Prevention an Control Act

Question 12

Controlled substances definition, categories, and the one responsible for it?

Answer 12

• Controlled substances are those that have a potential for abuse.
• They are Categorized by schedule (I-V), Based on therapeutic use and potential for abuse
• The Drug Enforcement Agency (DEA) requires that these drugs be stored securely and tracked rigorously, including tracking of the prescribing professional.

Adversed effect and addiction these two reasons make the drug need a prescreption or it can be over the counter medication

Question 13

Type I
Dispensing requirements
Examples

Answer 13

Dis: Drugs not approved for medical use, except specific protocols: high abuse potential.
Ex: LSD, marijuana, heroin, gamma-hydroxybutyrate (Ecstasy)

Question 14

Types II
Dispensing requirements
Examples

Answer 14

Dis: Drugs approved for medical use: high abuse potential. Must be kept in locked safe. No refills without a new prescription.
Ex: Opioid analgesics (e.g., codeine, morphine, hydromorphone, methadone, oxycodone), central nervous system stimulants (e.g., cocaine, amphetamine), depressants (e.g., barbiturates-pentobarbital)

Question 15

Types III
Dispensing requirements
Examples

Answer 15

Dis: Less potential for abuse than Schedule I or II drugs but may lead to psychological or physical dependence. Prescription expires in 6 months.
Ex: Anabolic steroids; mixtures containing small amounts of controlled substances, such as codeine

Question 16

Types IV
Dispensing requirements
Examples

Answer 16

Dis: Some potential for abuse. Prescription expires in 6 months.
Ex: Benzodiazepines (e.g., diazepam, lorazepam), other sedatives (e.g., phenobarbital), some prescription appetite suppressants (e.g., mazindol)

Question 17

Type V
Dispensing requirements
Examples

Answer 17

Dis: Written prescription requirements vary with state law.
Ex: Antidiarrheal drugs containing small amounts of controlled substances (e.g., Lomotil)
AKA: over the counter medications

Question 18

Cultural aspects of drug therapy
What are the considerations? 4 points

Answer 18

Health Providers most be aware of how patients’ different cultural beliefs and practices can affect health care. They also need to be aware of physical differences that can affect drug performance.&raquo_space;» Should not assume how a patient will respond

Cultural considerations such:
• Pain response
• Believe in alternative therapies (herbals, meditation…..)
• Ability to communicate effectively with healthcare team.
• Compliance with long-term therapy.

Question 19

What are the 8 rights of medication administrations?
3 categories 8 points

Answer 19

Most medication error result from the failure to follow one of these rights:

Focus: Right drug, dose, route, and time
Safe administration: Right reasons and documentation
To achieve: Right response

Question 20

Routes of drug administration?
The choice of routes depends on?

Answer 20

The choice of routes depend on:
• 1- Drug properties, e.g., water or lipid solubility, ionization,
• 2- Patient requirement

The routes can be divided into:
• Enteral
• Parenteral
• Topical

Question 21

Topical drugs:
3 points

Answer 21

1.Transdermal patch, lotions, creams, ointments, inhalation, ophthalmic, otic
2. Nasal drops or spray.
3.Vagal

Question 22

Rectal drugs:
2 points with 3 points Advantage and 2 points Disadvantage

Answer 22

Rectal:
-Rectum has rich blood supply and drugs can cross the rectum mucosa to be absorbed for systemic effects
-Drugs like: indomethacin, diazepam.
Advantages
1. Gastric irritation is avoided
2. Can be administered by unskilled persons
3. Useful in geriatric patients and others with vomiting and those unable to swallow.
Disadvantages
1. Irritation of rectum can occur
2. Absorption may be irregular and unpredictable

Question 23

Parenteral drugs:
5 points advantage 4 points disadvantage and 4 points routes

Answer 23

Parenteral Drug:
Advantages
1. Action is more rapid and predictable than oral administration
2. Can employed in an unconscious or uncooperative patients
3. Gastric irritants drugs can be given parenterally
4. Can be used in patients with vomiting or those unable to swallow
5. Digestion by the gastric and intestinal juices and first pass metabolism are avoided
Disadvantages
1. Aseptic techniques must be strictly applied
2. Injections may be painful
3. More expensive, less safe and inconvenient
4. Injury to nerves and other tissues may occur
Routes:
a) Intradermal b) Subcutaneous c) Intramuscular d) Intravenous route

Question 24

Enteral drugs:
3 routes 2 from the routes mention advantages and disadvantage

Answer 24

Enteral:
Tablete, capsule, or liquid
b) Sublingual
c) Buccal
d) Nasogastric and gastrostomy

Ingested drugs:
Advantages: Safest route , Most convenient ,
Most economical , Drugs can be self-
administrated
Disadvantages: Onset of action is slower as absorption need time, Irritant and unpalatable drugs cannot be administered , Some drugs may not be absorbed due to , certain physical characteristics, Irritation to GIT may lead to vomiting , Some drugs may be destroyed by gastric juices ,e.g., insulin , There may be irregularities in absorption , Some drug may undergoes extensive first , pass metabolism in the liver , Cannot be given to unconscious and uncooperative patients.

Sublingual: Here the tablet or pellet contain the drug is placed under the tongue, It dissolved and the drug is absorbed across the sublingual mucosa which is rich in blood capillaries E.g., Nitroglyceri, Nifedipine Advantages: Absorption is rapid within minutes the drug reach the circulation , First pass metabolism is avoided , After the desired effect is obtained, the drug can be spat out to avoid the unwanted side effects Disadvantages: Buccal ulceration.

Question 25

Routes of Drug Administration (Newer techniques for drug delivery) 2 main types

Answer 25

Implanted drug delivery system Targeting drug delivery to specific cells and tissue

Question 26

Implanted Drug Delivery System 6 points

Answer 26

Implanted Drug Delivery System It allows targeted and localized drug delivery and may achieve a therapeutic effect with lower drug concentrations • Thus; They may minimize potential side-effects of therapy and They Offer the opportunity for increased patient compliance • This type of system also has the potential to deliver drugs that would normally be unsuitable orally because it avoids: • First-pass metabolism • Chemical degradation in the stomach and intestine Thus, increasing bioavailability (F) • Implantable devices will require a healthcare professional for insertion, and the insertion itself will be a relatively invasive process. • However, unlike other methods this will only be required once. The prolonged drug delivery that will be achieved without the reliance on patient compliance overcomes these disadvantages.

Question 27

Targeting Drug Delivery to Specific Cells and Tissue 2 points

Answer 27

Targeting Drug Delivery to Specific Cells and Tissue • Antibody- and Peptide-Mediated Tissue- Specific Targeting Strategies • Antibody-mediated targeting strategies: Selection of an antibody that can specifically bind to antigens with high expression on target cells and with little to no expression in normal tissues is the key to establish ideal ligand-target pair selection for antibody- mediated targeting strategies.

Question 28

Pharmacodynamics Mechanism Of Action: 4 points

Answer 28

Pharmacodynamics Mechanism Of Action • Focus on what a drug does to the body. Thus describe the drug’s target site. It describe the molecular interactions of a drug with specific biological molecules that lead to a desired therapeutic response. • Most drugs effects resulted from their interactions with receptors molecules, (Lock and Key model). The receptor is the lock, and the drug is the key. • Most these targeted receptors are either on the cell surface or inside the cells . They typically bind to targeted LIGANDS that when bond to cause stimulation of the receptor activity. • The Drug-receptor/Ligand-receptor bonding are either (reversible) or (irreversible). Its strength is measured in term of affinity>>> higher affinity meaning stronger and longer duration of action Re can be toxic Irr is not toxic because it will leave when broken down

Question 29

Pharmacokinetics: 4 points

Answer 29

Pharmacokinetics •Focuses on‘What the body does to the drug’and quantifies the rate of drug movement in the body. It characterize the speed of drug ABSORTION, DISTRIBUTION, METABOLISEM and ELEMINATION.: • Absorption: Movement of drug from into systemic circulation • Distributio: Movement of drug out of systemic circulation to its target site of action. • Metabolism: Chemical alteration of drug and producing metabolite • Eliminatio: Irreversible Excretion of drug from the body

Question 30

Toxicology: 3 points

Answer 30

• Is the Study and characterization of adverse effects caused by high conc. Of drug in the body , and the harmful , potentially fatal effects that may result. • (Dose dependent): Most drugs are potential to become toxic; that’s depends on the dose or amount of the drug that administrated to the patient. • To determine the optimal beneficial dose of drug, a throughout examination of factors which effect drug fate in the body; what dose the drug do to the body ( Pharmacodynamic)? And what dose the body do to the drug ( Pharmacokinetic ).

Question 31

Types of receptors: 3 points

Answer 31

Types of Receptors • Extracellular receptors: Located outside the target cell • Transmembrane receptors: Cross the cell membrane • Intracellular receptors: Located inside the target cell

Question 32

Classes of Medications According to their receptor- binding

Answer 32

Agonist drugs: • Mimic ligand-receptor activation responses; produce a stimulation-type. —Full Agonist: elicit maximal receptor stimulation. —Partial Agonist: activate receptor but are unable to elicit maximum stimulation. Antagonist drugs: • Block the receptor’s activation response • It can be either reversible ( overcome by increasing agonist conc.) or irreversible.

Question 33

Pharmacokinetic Parameters Used to Characterize Rate of Drug Movement 4 Ks and 1 t

Answer 33

• k = rate constant of drug’s movement • ka = rate constant for drug absorption • kd = rate constant for drug distribution • ke = rate constant for drug elimination • t1/2 = the drug’s half-life

Question 34

Drug absorption: ADME A 2 points

Answer 34

• The rate of drug absorption depends on the rout of administratio n (ROA). • Forms of Drugs ROA: orally, sublingual, suppository, IV……

Question 35

Drug absorption: ADME D 3 main points with 4 small ones

Answer 35

• Distribution level of drug determine its duration of action in the body; high distributed drug mean it stays in the tissue/organ for a while before returning to the bloodstream circulation and its eliminatio.While little or no distribution mean the drug spends much less time in the body and its eliminated quickly. • Ideally, a drug would travel directly to its site of action without affecting any other sites in the body. • However, because drug travels through bloodstream, unintended site within the body are also exposed to the drug, leading to side effects - (desired effect): Therapeutic response - (rare): No therapeutic responses - (Common): Side Effect - (Uncommon): Adverse Events

Question 36

Drug absorption: ADME M 6 points

Answer 36

• Most ingested soluble chemical substances are absorbed from small intestine to the hepatic portal vein, which leads to the liver. • Liver serves as the ”filter” through which compounds are “screened/metabolized”. The outcome of the metabolized products “ metabolites” may either be active metabolite retaining pharmacologic activity, or an inactive metabolite unable to elicit a therapeutic response. • This process called “FIRST PASS METABOLISEM”, thus the amount of drugs capable of producing a therapeutic responses < than the amount of ingested drugs orally • The liver metabolization process is crucial to eliminate drugs from the body system, by converting the drug to more water-soluble compound. • The most notable hepatic enzyme responsible for drug metabolizing is CYTOCHROM P-45/ Cyt-450. • Patient with impaired liver function will not have the same hepatic metabolism capacity and may require a lower dosage, to prevent drug toxicity

Question 37

Drug absorption: ADME E 5 points

Answer 37

• The main drug elimination rout is the bile system and the urine. • Biliary excretion of drugs: general rules • Molecular weight (MW) > 500 : mainly excreted in bile. • MW of 300– 500: excreted in urine and bile • MW < 300: almost exclusively excreted via the kidneys into urine

Question 38

Possible Outcomes of Drug Administration 4 points

Answer 38

• Therapeutic response: Intended response • No therapeutic response • Side effects: Responses in tissues outside of the target • Adverse event: —Unintended effect that causes harm —Often requires discontinuation of medication